Financial incentives for quitting smoking in pregnancy: are they cost-effective

Aims: To evaluate whether adding financial incentives to usual care is cost-effective in encouraging pregnant women to quit tobacco smoking, compared with usual care alone. Design: Cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a healthcare provider’s perspective, embedded in the Smoking Cessation in Pregnancy Incentives Trial (CPIT III). Long-term analyses were conducted from the same perspective, using an existing Markov model over a lifetime horizon. Setting: Seven maternity smoking cessation sites in Scotland, England and Northern Ireland in the United Kingdom. Participants: In the short-term analysis CPIT III participants were assessed: women 16 years or older, self-reporting as smokers, less than 24 weeks pregnant and English speaking (n=944). The same population was used for the lifetime analysis, plus their infants. Measurements: Costs included financial incentive vouchers and postage, cessation support and nicotine replacement therapy and neonatal stays. The outcome measure was biochemically verified quit rate for the CEA and quality adjusted life-years (QALY) for CUA. Costs are presented in 2020 GBP sterling (£). Data for the lifetime analysis came from the trial and were combined with data from published literature embedded in the model, reporting incremental cost per quitter and QALY. A 3.5% discount rate was applied. Findings: The short-term incremental cost per quitter was £4,400 and cost per QALY was £150,000. Results of sensitivity analyses confirmed these results. The long-term analysis combined costs and outcomes for mother and infants; results showed a cost saving of £37 (95% confidence interval [CI] = £35 to £106) and increase in QALYs of 0.171 (95%CI = 0.124 to 0.229). These findings indicate that, over a lifetime, financial incentives are cost saving and improve health outcomes. Conclusions: In the United Kingdom, offering up to £400 financial incentives, in addition to usual care, to support pregnant women to stop smoking appears to be highly cost-effective over a lifetime for mother and infants